本文選題：內(nèi)鏡黏膜下剝離術(shù)　切入點(diǎn)：早期胃癌　出處：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:當(dāng)前我國人民對(duì)健康篩查的重視不斷提高,而內(nèi)鏡設(shè)備的更新?lián)Q代,使早期胃癌及早期食管癌的檢出率逐步提高。早診斷和早治療使患者極大獲益,顯著提高了生存期及生存質(zhì)量。既往外科手術(shù)是胃癌及食管癌的首選治療方式,近年來內(nèi)鏡治療在早期胃癌及食管癌的治療領(lǐng)域已得到較大的發(fā)展。內(nèi)鏡黏膜下剝離術(shù)(ESD)作為消化道早癌的一種治療手段,已在國內(nèi)廣泛開展。而內(nèi)鏡黏膜下剝離術(shù)對(duì)治療消化道早癌的療效及影響因素有待繼續(xù)探索和驗(yàn)證。本文旨在統(tǒng)計(jì)分析及報(bào)道本中心近5年的研究成果,以期進(jìn)一步明確內(nèi)鏡黏膜下剝離術(shù)治療早期胃癌及早期食管癌的療效及其相關(guān)影響因素,為臨床醫(yī)師的決策制定提供理論依據(jù)。方法:本研究回顧下分析了于浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院消化內(nèi)科行ESD術(shù)的120例早期胃癌患者及30例早期食管癌患者的療效及相關(guān)影響因素。應(yīng)用Cox回歸模型進(jìn)行生存分析,而生存曲線以Kaplan-Meier方法繪制。采用卡方檢驗(yàn)或Fisher精確概率法評(píng)估切緣情況與其他臨床及病理特征之間的關(guān)聯(lián)性。結(jié)果:本研究結(jié)果顯示ESD治療早期胃癌的手術(shù)并發(fā)癥發(fā)生率為9.2%,切緣陽性率為5.8%,術(shù)后平均住院日約7.6天,術(shù)后的3年及5年總體生存率分別為97.5%和94.1%,同時(shí)3年及5年無復(fù)發(fā)生存率分別為95.2%和77.7%。生存分析提示性別、老年情況、腫瘤分化程度、浸潤深度、并發(fā)癥情況等均不影響患者的總體生存率及無復(fù)發(fā)生存率(P≥0.05)。而切緣陽性的患者更容易復(fù)發(fā),是患者復(fù)發(fā)的獨(dú)立影響因素(HR=6.05,95%CI:1.39-26.29;P=0.016)。進(jìn)一步探索發(fā)現(xiàn),切緣陽性與浸潤深度及超聲內(nèi)鏡檢查相關(guān)(OR=17.5;95%CI:3.32-92.09;OR=1.66;95%CI:1.43-1.93)。另一方面,我們的研究結(jié)果顯示:ESD治療早期食管癌的手術(shù)并發(fā)癥發(fā)生率為13.3%,切緣陽性率為10.0%,術(shù)后平均住院日約9.5天,亦提示ESD是治療早期食管癌的有效治療手段。結(jié)論:本研究發(fā)現(xiàn),ESD是治療早期胃癌及早期食管癌有效且安全可靠的治療方式。ESD具有創(chuàng)傷小、并發(fā)癥少、住院時(shí)間短等優(yōu)點(diǎn)。切緣陽性是早期胃癌ESD術(shù)后復(fù)發(fā)的獨(dú)立影響因素,術(shù)前的超聲內(nèi)鏡檢查有利于進(jìn)一步明確病灶侵犯層數(shù),從而優(yōu)化病例篩選,減少切緣的陽性率。
[Abstract]:Background: at present, people in our country pay more and more attention to health screening, and the rate of detection of early gastric cancer and early esophageal cancer is gradually increased with the replacement of endoscopic equipment. Early diagnosis and early treatment greatly benefit patients. The survival time and quality of life were significantly improved. Surgical treatment was the first choice of treatment for gastric cancer and esophageal carcinoma. In recent years, endoscopic therapy has been developed in the field of early gastric cancer and esophageal cancer. Endoscopic submucosal dissection (ESD) is a treatment for early gastrointestinal cancer. The therapeutic effect of endoscopic submucosal dissection on early cancer of digestive tract and its influencing factors need to be further explored and verified. The purpose of this paper is to analyze and report the results of the study in the past 5 years. To further determine the therapeutic effect of endoscopic submucosal dissection for early gastric cancer and early esophageal carcinoma and its related factors. Methods: 120 cases of early gastric cancer and 30 cases of early esophageal cancer treated with ESD in the Department of Digestive Medicine affiliated to the first Hospital of Zhejiang University Medical College were analyzed retrospectively. Cox regression model was used for survival analysis. The survival curve was plotted by Kaplan-Meier method. The correlation between cutting margin and other clinical and pathological features was evaluated by chi-square test or Fisher precise probability method. Results: the results of this study showed that ESD was used to treat early gastric cancer complicated by surgery. The incidence of symptoms was 9.2 and the positive rate of incision margin was 5.8. The average hospital stay after operation was about 7.6 days. The overall 3-year and 5-year survival rates were 97.5% and 94.1%, respectively, and the 3-year and 5-year recurrence free survival rates were 95.2% and 77.7%, respectively. The complications did not affect the overall survival rate and the recurrence free survival rate (P 鈮，

本文編號(hào)：1667599